<?php

require 'header.php';

?>
      <div class="middle">
		<div class="simple-container-left" id="page:main-container">
			<div class="container" id="page:container">
				<div class="main">
					<div class="content-container">
						<div class="content" id="content">
							<div class="content-header">
								<table class="grid-header" cellspacing="0" border="0" >
									<tbody>
										<tr>
											<td width="60%"><h3 class="icon-head head-customer">Manage Loan</h3></td>
                                            <td ><h3 class="icon-head head-user">ID : 20080001 &nbsp; Name : Jundie Chan</h3></td>
										</tr>
									</tbody>
								</table>
							</div>
							<form name="form1" id="form1" action="/" method="post">
							<div class="entry-edit">
                                <br />
								<h4 class="icon-head head-edit-form fieldset-legend">Edit Co-Borrower Information</h4>

									<table width="100%" cellspacing="10" border="0" style="background-color:#eeeeee" >
									<tbody>
								        <tr>
         							        <td>
         							            	<table width="100%" cellspacing="0">
										<tbody>
										<tr>
										    <td>
                                            <table width="100%" cellspacing="0" border="0">
										           <tbody>
										                  <tr>
										                      <td>
										                          <table width="100%" cellspacing="5" border="0">
										                          <tbody>
                                                                         <tr>
                                                                             <td>Co-Borrower ID</td>
                                                                             <td>2008001</td>
                                                                         </tr>
                                                                         <tr>
																             <td>Status Date <span class="required">*</span></td>
																             <td>03/5/08</td>
															             </tr>
															             <tr>
																             <td>Last Name <span class="required">*</span></td>
																             <td><input name="borrower_lastname" value="" class="required-entry required-entry input-text" type="text"></td>
															             </tr>                                                                                                                        <tr>
																             <td>First Name <span class="required">*</span></td>
																             <td><input name="borrower_firstname" value="" class="required-entry required-entry input-text" type="text"></td>
															             </tr>
															             <tr>
																             <td>Middle Name</td>
																             <td><input name="borrower_middlename" value="" class="required-entry required-entry input-text" type="text"></td>
															             </tr>
															             <tr>
																             <td>Address <span class="required">*</span></td>
																             <td><textarea name="borrower_address" cols="20" rows="2"></textarea></td>
															             </tr>
															             <tr>
																             <td>Barangay <span class="required">*</span></td>
																             <td><input name="borrower_barangay" value="" class="required-entry required-entry input-text" type="text"></td>
                                                                         </tr>
															             <tr>
																             <td>City <span class="required">*</span></td>
																             <td><input name="borrower_city" value="" class="required-entry required-entry input-text" type="text"></td>
															             </tr>
															             <tr>
																             <td>Island <span class="required">*</span></td>
																             <td><input name="borrower_island" value="" class="required-entry required-entry input-text" type="text"></td>
															             </tr>
														         </tbody>
													             </table>
												             </td>
												             <td>
												                 <table width="100%" cellspacing="5"border="0">
														         <tbody>
															         <tr>
                                                                        <td width="50%"><br  /><br /><br />Picture </td>
																        <td align="left" width="50%"><img src="img/no_photo.jpg" width="120" height="120" /><br />
																        <input name="borrower_photo" value="" class="required-entry required-entry input-text" type="file"></td>

															        </tr>
                                                                    <tr>
																             <td>Phone <span class="required">*</span></td>
																             <td><input name="borrower_phone" value="" class="required-entry required-entry input-text" type="text"></td>
															             </tr>
															             <tr>
																             <td>Mobile </td>
																             <td><input name="borrower_mobile" value="" class="required-entry required-entry input-text" type="text"></td>
															             </tr>
															             <tr>
																             <td>Birthdate <span class="required">*</span></td>
																             <td><input name="borrower_birthdate" value="" class="required-entry required-entry input-text" type="text"></td>
															             </tr>
															             <tr>
																             <td>Gender <span class="required">*</span></td>
																             <td><select name="borrower_gender" class="required-entry required-entry select" type="select">
								                                                   <option value="1">Male</option>
																	               <option value="2">Female</option>
																	             </select>
																             </td>
															             </tr>
															             <tr>
																             <td>Civil Status <span class="required">*</span></td>
																             <td><select name="borrower_civil_status" class="required-entry required-entry select" type="select">
																	               <option value="1">Single</option>
																	               <option value="2">Married</option>
																	               <option value="3">Divorced</option>
																	               <option value="4">Separated</option>
																	               <option value="5">Widowed</option>
																	             </select>
																              </td>
															             </tr>
                                                                         </tr>
																         <tr>
																             <td>Co-Borrower Status <span class="required">*</span></td>
																             <td><select name="borrower_status" class="required-entry required-entry select" type="select">
																	                 <option value="1">Active</option>
																	                 <option value="2">Inactive</option>
																	             </select>
																</td>
															</tr>
														        </tbody>
													            </table>
												            </td>
								                        </tr>

										           </tbody>
									               </table>
                                             </td>
                                             </tr>
                                             <tr align="center">
                                            <td><br /><button type="button" class="scalable back" onclick="setLocation('add_borrower_wizard.php')" style=""><span>Reset</span></button>
                                                <button type="button" class="scalable cancel" onclick="setLocation('loan.php')" style=""><span>Cancel</span></button>
                                                <button type="button" class="scalable save" onclick="setLocation('loan.php')" style=""><span>Save</span></button>
                                            </td>
                                        </tr>
                                             </table>

	                                        </td>
	                                     </tr>
	                                    <tr>
	                                     <td>
	                                    </td>
	                                   </tr>
										</tbody>
									</table>
									&nbsp;   
							</div>


							</form>
						</div>
					</div>
					
					<div class="section-menu" id="page:left">
						<h3>Loan Center</h3>
						<ul id="loan_info_tabs" class="tabs">
							<li>
						        <a href="loan_view.php" title="Loan" class="tab-item-link active">
					            <span><div class="changed" title="The information in this tab has been changed."></div><div class="error" title="This tab contains invalid data. Please solve the problem before saving.">
								</div>Co-Borrower Information</span>
						        </a>
						    </li>
						</ul>
						<div class="bottom"></div>
					</div>
              	</div>
			</div>
		</div>
	</div>

<?php

require 'footer.php';

?>